Pakistan: Blame Your Spies for the Explosion of Polio

Polio is a viral disease that can affect the nerves and lead to full or partial paralysis. The most likely to get affected are the elderly, pregnant women and children under 5. Due to a global vaccination campaign, polio exists only in a handful of nations. One of these is Pakistan. According to the WHO, polio has declined from just under 1200 cases in 1997 to 28 cases in 2005. This is a remarkable trend that could see Pakistan finally become polio free.

Graph Polio Cases in Pakistan 1997-2008

To combat polio, the Government of Pakistan re-evaluated its National Emergency Action Plan (NEAP) and set the ambitious goal of eradicating all wild polio in Pakistan by the end of 2012. This plan seeks better accountability and program management. In the districts where polio infections are high, such as those in the Federally Administered Tribal Areas (FATA), the plan seeks to improve the security situation in these areas so that health workers can have better access to vulnerable children.

Last of all, the plan calls for an aggressive media campaign to educate and inform at-risk communities about the risks of polio and the need for vaccination.On the international level, the WHO launched the Global Polio Eradication Initiative in Pakistan in 1994. This is a public-private partnership between the WHO, UNICEF, the Bill and Melinda Gates Foundation and other donors. Since 2000, it has followed the successful approach of supplementing routine polio immunization with large countrywide campaigns several times a year in an attempt to deliver the vaccine to all children under five.

Though the drastic decrease in polio in Pakistan may be cause for celebration, this progress hangs in the balance. In 2011, Pakistan recorded 198 cases of polio, up from the 28 in 2005. This causes grave concern to health officials, especially after a militant group based in North Waziristan, a region in the (FATA) warned polio vaccination teams to stay away or face serious consequences. This puts 280,000 children at risk from polio. These groups allege that the vaccination efforts are being used as cover for US spies to gather information for future drone strikes against Pakistan. These allegations are not unfounded. As part of the extensive preparations for the raid on Osama Bin Laden’s compound, the CIA recruited a senior Pakistani doctor, Shakil Afridi to organize a fake vaccine drive in Abbottabad. This was an attempt to obtain the DNA of Bin Laden’s family to make sure that Bin Laden was present at the suspected compound.

As a result, many multimillion dollar aid projects were put at risk. Save the Children had its senior managers prevented from leaving the country and staff have been denied visas. A few months after the raid, customs officials at Islamabad Airport impounded a shipment of medicines. As a result, 35,000 children in the tribal areas missed their treatments.

Other aid agencies had similar complaints. InterAction, a consortium of 200 American NGOs said that they feared that the CIA’s actions contributed to the increase in violence against aid workers. A few days ago, gunmen opened fire on a UN vehicle in Karachi, wounding a doctor and his driver who were participating in the National Immunization Days (NIDs), a three day polio vaccination drive in Pakistan.

In March, the WHO warned that Pakistan could faceinternational travel sanctions if it failed to eradicate polio. As many as 200,000 children have missed their polio vaccinations in the past two years. In response, the Pakistani government began taking a more “muscular approach” to polio. The government has made vaccination mandatory and started to fine parents who do not vaccinate their children. Religious groups have been persecuted for spreading lies about the vaccinations and children are being barred from school if they are not vaccinated.

Pakistan faces many challenges in its fight to eradicate polio. Not only do they have to overcome the logistical and organizational barriers, but they also have to worry about the unintended consequences of foreign nations’ national security and foreign policies. As the Washington Post puts it, trust is essential for a successful global health campaign. Locals often link healthcare with security. Now, health workers in Pakistan are suspected of being spies.

This undermines years of hard work and negotiations by health agencies to overcome religious and cultural barriers to deliver lifesaving treatments. This begs the question, should national security and foreign policy objectives outweigh an initiative that could potentially save thousands of lives? If the US or another country is put in a similar situation in the future, what should their decision be?